Do cryoballoon or pulsed field ablation improve pulmonary vein isolation durability compared to radiofrequency ablation in patients undergoing redo procedures for atrial fibrillation?
In patients undergoing redo ablation for atrial fibrillation, index procedures with cryoballoon or pulsed field ablation demonstrated greater pulmonary vein isolation durability than radiofrequency ablation.
Abstract Background Pulsed field ablation (PFA) is a non-thermal ablation modality. Comparative durability of pulmonary vein isolation (PVI) versus radiofrequency (RF) and cryoballoon (CB) remains incompletely defined. Objective To compare PVI durability and pulmonary vein (PV) reconnection patterns at redo procedures after index AF ablation with RF, CB, or PFA. Methods Consecutive patients from a prospective single-center high-volume registry who underwent a redo procedure after index PVI between 2015 and 2024 were included. Index procedures used contact-force RF, CB, or a pentaspline PFA catheter. During redo, PVI durability and PV reconnection patterns were assessed using high-density mapping. Pairwise matched comparisons were performed. Results Of 5,620 index ablations, 509 (9.1%) underwent redo: RF 329, CB 119 and PFA 61. The proportion of patients with ≥1 reconnected PV was 57.1% after RF (188/329), 42.0% after CB (50/119), and 39.3% after PFA (24/61). Matched pairwise comparisons were significant for RF vs CB (p=0.014) and RF vs PFA (p=0.021), with no difference between CB and PFA (p=0.730). Per-vein reconnection rates were 426/1316 (32.4%) for RF, 98/476 (20.6%) for CB, and 40/244 (16.4%) for PFA; RF differed from both CB and PFA (both p0.0001), while CB vs PFA was not different (p=0.225). The most frequently reconnected veins were the right superior (RSPV) and right inferior after RF (66.9% and 62.3%) and CB (68.1% and 57.4%), whereas after PFA the RSPV and left superior PV predominated (53.3% and 46.7%). In the multivariable model with PV reconnection as the dependent variable, recurrence presenting as a persistent arrhythmia was independently associated with lower odds of PV reconnection (OR 0.30, 95% CI 0.16–0.54; p0.001), consistent with greater PVI durability. Conclusions In this single-center redo cohort, CB and PFA were associated with greater PVI durability—fewer patients with reconnection and fewer reconnected veins—than RF.PanelForest Plot
Zaher et al. (Mon,) studied this question.
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